Email recruitment to use web decision support tools for pneumonia.
Application of guidelines to improve clinical decisions for Community Acquired Pneumonia (CAP) patients depends on accurate information about specific facts of each case and on presenting guideline support at the time decisions are being made. We report here on a system designed to solicit information from physicians about their CAP patients in order to classify CAP and present appropriate guidelines for type of care, length of stay, and use of antibiotics. We used elements of three existing information systems to create a achieve these goals: professionals coding diagnoses captured by the existing clinical information system (CIS), email, and web-based decision support tools including a pneumonia severity evaluation tool (SET). The non-secure IS components (email and web) were able to link to information in the CIS using tokens that do not reveal confidential patient-identifiable information. We examined their response to this strategy and the accuracy of pneumonia classification using this approach compared to chart review as a gold standard. On average physicians responded to email solicitations 50% of the time over the 14 month study. Also using this standard, we examined various information triggers for case finding. Professional coding of the primary reason for admission as pneumonia was fairly sensitive as an indicator of CAP. Physician use of the web SET was insensitive but fairly specific. Pneumonia classification using the SET was very reliable compared to experts' chart review using the same algorithm. We examined the distribution of severity of pneumonia for cases of pneumonia found by the various information triggers and for each severity the average length of stay. The distribution found by both chart review and by SET has demonstrated a shift toward more severe cases being admitted compared to only 3 years ago. The length of stay for level of severity is above expectations published by guidelines even for cases of true CAP by chart review. We suggest that the Fine classification system may not adequately describe patients in this setting. Physicians frequently responded that the guidelines presented did not fit their patients. (+info
In their own words? A terminological analysis of e-mail to a cancer information service.
OBJECTIVE: To better understand the terms used by consumers to describe their health information needs and determine if this "consumer terminology"differs from those used by health care professionals. METHODS: Features and findings identified in 139 e-mail messages to the University of Pittsburgh Cancer Institute's Cancer Information and Referral Service were coded and matched against the 2001 Unified Medical Language System Metathesaurus. RESULTS: 504 unique terms were identified. 185 (36%) were exact matches to concepts in the 2001 UMLS Metathesaurus (MTH). 179 (35%) were partial string matches; 119 (24%) were known synonyms for MTH concepts; and 2 (<1%) were lexical variants. Only 19,or 4% of the total terms, were not found to be present in the 2001 MT1H. CONCLUSION: 96% of the clinical findings and features mentioned in e-mail by correspondents who did not self-identify as healthcare professionals were described using terms from controlled healthcare terminologies. The notion of a paradigmatic "consumer" who uses a particular vocabulary specific to her "consumer" status may be ill-founded. (+info
Cumulative trauma disorder risk for children using computer products: results of a pilot investigation with a student convenience sample.
OBJECTIVES: Cumulative trauma disorder is a major health problem for adults. Despite a growing understanding of adult cumulative trauma disorder, however, little is known about the risks for younger populations. This investigation examined issues related to child/adolescent computer product use and upper body physical discomfort. METHODS: A convenience sample of 212 students, grades 1-12, was interviewed at their homes by a college-age sibling or relative. One of the child's parents was also interviewed. A 22-item questionnaire was used for data-gathering. Questionnaire items included frequency and duration of use, type of computer products/games and input devices used, presence of physical discomfort, and parental concerns related to the child's computer use. RESULTS: Many students experienced physical discomfort attributed to computer use, such as wrist pain (30%) and back pain (15%). Specific computer activities-such as using a joystick or playing noneducational games-were significantly predictive of physical discomfort using logistic multiple regression. Many parents reported difficulty getting their children off the computer (46%) and that their children spent less time outdoors (35%). CONCLUSIONS: Computer product use within this cohort was associated with self-reported physical discomfort. Results suggest a need for more extensive study, including multiyear longitudinal surveys. (+info
PoPMuSiC, rationally designing point mutations in protein structures.
PoPMuSiC is an efficient tool for rational computer-aided design of single-site mutations in proteins and peptides. Two types of queries can be submitted. The first option allows to estimate the changes in folding free energy for specific point mutations given by the user. In the second option, all possible point mutations in a given protein or protein region are performed and the most stabilizing or destabilizing mutations, or the neutral mutations with respect to thermodynamic stability, are selected. For each sequence position or secondary structure the deviation from the most stable sequence is moreover evaluated, which helps to identify the most suitable sites for the introduction of mutations. (+info
Virtual connections: Internet health care.
Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery that provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The 20th century success of the Internet is now translating into changes in 21st century medical practice. The changes brought about by the Internet have at once facilitated and complicated the practice of medicine. Physicians and patients are challenged to take advantage of the increased opportunities afforded by Internet access while being mindful of its drawbacks and the limitations to virtual communication. The case of Karen Parles, one of the authors, is presented. Karen developed locally advanced lung cancer and used the Internet to research her diagnosis. She found the information on lung cancer limited and confusing, and, in response, developed a website devoted to empowering lung cancer patients in their search for information and support (http://www.lungcanceronline.org). Here we discuss issues surrounding patients' use of the Internet for health information and communication with health care providers. The value of information-seeking as a coping mechanism is debated, and concerns are raised regarding confidentiality of electronic communications and the logistics of physicians adopting e-mail as a mechanism for communicating with patients. (+info
Acupuncture for tennis elbow: an E-mail consensus study to define a standardised treatment in a GPs' surgery.
Acupuncture is a possible alternative treatment for tennis elbow in general practice. Rigorous investigation of its effectiveness is needed by means of a randomised controlled trial. Before undertaking a trial, a consensus is required on the best treatment protocol. Therefore, a modified Delphi Process was undertaken by e-mail, consisting in three iterative rounds. Fourteen acupuncture trainers initially reported details of their normal treatment that were then incorporated into a treatment plan. This was circulated once for further suggestions and finally for agreement. Consensus was achieved from all 14 participants who responded to the third round. (+info
Web messaging: a new tool for patient-physician communication.
OBJECTIVE: There is a high demand by patients to communicate electronically with their doctor. This study evaluates the use of a web messaging system by staff and patients of UC Davis community Primary Care Network (PCN) clinic. DESIGN: Eight providers and their staff and patients were surveyed on use of this web messaging system, and physician productivity was measured with Relative Value Unit (RVU) and office visit data. RESULTS: 36.9% (238/645) of registered users responded to the survey. The web messaging system was preferred over phone calls by both providers and patients for the communication of non-urgent problems. A great majority of patients found it easy to use (88.8% or 206/232) and were satisfied (85.8% or 199/232). Satisfaction was significantly associated with timely provider response (Goodman-Kruskal Gamma = 0.667, 95% CI = 0.546-0.789). Clinicians were also favorable to the system and, despite concerns, were not inundated with messages. Most found it easy to use, perceived it to improve patient communication, and valued the insurance reimbursement capability. Furthermore, the system did not have a negative impact on physician productivity. CONCLUSION: A patient-provider web messaging system, which provides a combination of security and access controls, customized routing, rich knowledge content, and insurance reimbursement capability, is a useful addition to the array of communication options available to health care providers and their patients. (+info
Dietary advice in clinical practice: the views of general practitioners in Europe.
BACKGROUND: General practitioners (GPs) can promote good nutrition to patients and advise them about desirable dietary practices for specific conditions. OBJECTIVE: The objective was to assess GPs' knowledge and attitudes in implementing preventive and health promotion activities and to describe tools used by European GPs in advising patients about dietary practices. DESIGN: A postal survey was mailed to 1976 GPs from 10 GP national colleges to obtain information about beliefs and attitudes in prevention and health promotion, and an e-mail survey was sent to 15 GPs representing national colleges to obtain information about dietary guidelines. RESULTS: In the postal survey, 45% of GPs reported estimating body mass in clinical practice, and 60% reported advising overweight patients to lose weight. Fifty-eight percent answered that they felt minimally effective or ineffective in helping patients achieve or maintain normal weight. In the e-mail survey, only 4 colleges out of 15 reported that they had published their own dietary tools, although 10 out of 15 answered that GPs use some nutritional/dietary recommendations in the office when seeing patients. Eleven out of 15 answered that both the nurse and the GP advise patients about dietary practices, with 4 answering that GPs were the only ones who advise patients. Only 5 delegates answered that they can refer their patients to trained nutrition specialists. CONCLUSIONS: GPs think that obesity is not easy to handle in practice. Most GPs have dietary tools in the office and think that nurses play an important role in advising patients. (+info